Nosocomial Tuberculosis Risk Assessment and Management Recommendation for an Emergency Department in a University Hospital
Wiroj Jiamjarasrangsi MD, PhD*, Sarawuth Urith BSc*, Wisaruth Srisintorn MD*
Affiliation : * Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University
Objectives : To assess the nosocomial TB risk and recommend appropriate risk management procedure for the
trauma ward of the emergency department at a university hospital in Bangkok.
Materials and Methods : The risk assessment procedure includes: (1) estimating the number of healthcare visits
of the TB patients at the trauma ward of emergency department in 2004; (2) determining the TB incidence rate
among the healthcare workers (HCWs) of the trauma ward during 2004-2005; and (3) surveying the indoor
environment (particularly concerning the ventilation condition) of the targeting ward. Appropriate risk
management procedures were then recommended based on the guidelines provided by The World Health
Organization (WHO) and The Centers for Disease Control and Prevention (CDC) of the United States.
Results : The estimated number of healthcare visits of the TB patient at the trauma ward in 2004 was 20. During
2004-2005, there were 4 out of 57 HCWs at the trauma ward who developed tuberculosis; among these were
two registered nurses and two nursing auxiliaries. The TB incidence rates among these HCWs were 3,509 per
100,000 person-year overall (or 2,632 per 100,000 person-year for confirmed TB cases only) and 3,333 (or
1,667 for confirmed TB cases only) and 4,761 per 100,000 person-year for registered nurse and nursing
auxiliary. The ventilation in the trauma inpatient ward had 1.43 air changes per hour, which was below the
recommended standard value. Turbulence pattern of airflow, which promotes airborne TB spreading in this
area, was also detected.
Conclusion : The risk assessment results showed that the trauma ward of the emergency department at this
university hospital has a high risk for nosocomial tuberculosis. Appropriate risk management procedures,
which are in accord with the standard guidelines, should be urgently implemented.
Keywords : Risk assessment, Nosocomial tuberculosis, Emergency department
